Abaluck Jason, Agha Leila, Kabrhel Chris, Raja Ali, Venkatesh Arjun
Yale University and NBER.
Boston University and NBER.
Am Econ Rev. 2016 Dec;106(12):3730-3764. doi: 10.1257/aer.20140260.
A large body of research has investigated whether physicians overuse care. There is less evidence on whether, for a fixed level of spending, doctors allocate resources to patients with the highest expected returns. We assess both sources of inefficiency exploiting variation in rates of negative imaging tests for pulmonary embolism. We document enormous across-doctor heterogeneity in testing conditional on patient population, which explains the negative relationship between physicians' testing rates and test yields. Furthermore, doctors do not target testing to the highest risk patients, reducing test yields by one third. Our calibration suggests misallocation is more costly than overuse.
大量研究调查了医生是否过度使用医疗服务。对于在固定支出水平下医生是否将资源分配给预期回报最高的患者，证据较少。我们利用肺栓塞阴性影像检查率的差异评估了这两种低效率来源。我们记录了在患者群体条件相同的情况下，医生之间在检查方面存在巨大差异，这解释了医生检查率与检查产出之间的负相关关系。此外，医生没有将检查针对最高风险患者，导致检查产出降低了三分之一。我们的校准表明，资源分配不当比过度使用造成的成本更高。
